Tag: moral obligations

Bioethics Blogs

Trust, Communities, and the Standing to Hold Accountable

by Thomas Wilk 

ABSTRACT. During the 2016 US Presidential campaign and in the aftermath of the election of Donald Trump, many of us have tried to hold friends, family, and acquaintances accountable for their support of a candidate and campaign that we judged to be racist, xenophobic, sexist, transphobic, ableist, and authoritarian. Even when our friends and family avowed, for example, anti-racist norms, our attempts to hold them to those norms were often met with rejections of our standing to do so: What gives you the right to call me out for my vote? In this paper, I argue for the regrettable conclusion that these challenges to our standing to hold are, in at least some cases, justified on the grounds that the targets of our holdings have little evidence that we would allow ourselves to be reciprocally held accountable. As such, recognizing our standing to hold them accountable would be a threat to their agency. I conclude by arguing that we now ought to engage in a project of rebuilding the kinds of communities in which the mutual trust that is foundational to our moral practices can be rebuilt.

 

INTRODUCTION

Who are you to tell me what I should do? What gives you the right to order me around? How dare you call me a racist!? Many of us have heard these refrains over the course of the 2016 US Presidential campaign and since the election of Donald Trump. We try talk to Trump supporters—family, former classmates, hometown friends, and online acquaintances—about the racism, xenophobia, sexism, transphobia, ableism, and authoritarianism that some of us have judged to be endemic to his campaign and nascent administration.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Rethinking The Obligation To Provide Universal Healthcare Coverage: The need for moral imagination

Healthcare is indeed complicated, in case anyone with a
speck of knowledge about it ever thought otherwise. There are many ways to
organize a healthcare system, as is evident from all the various ways advanced
industrial societies around the globe provide healthcare to their citizens.
Questions about the extent to which the private insurance system versus the
government is involved brings us back to protracted debates about the legitimate
role of government and whether or not citizens have a basic right to healthcare,
or should healthcare be assumed to be one more market service which individuals
may elect to use or not? Sadly, in the United States these questions often are
framed in abstract terms appealing to general ideological values and goals that
shape and limit the range of viable policy options. What I want to emphasize in
my blog today is the need for moral imagination—what’s it like to be in the
shoes of those who are suffering, and often without health insurance, and
without a job?  This is a first step we
all must take before we can weigh our moral obligations to provide healthcare
to everyone.

Before the passage of the Affordable Care Act (ACA) there
were over 45 million uninsured Americans who did not have access to a primary
care physician. That number has been reduced by about 18 million, but now we at
risk of seeing this number rise again with the possibility of a repeal of the
ACA and passage of a GOP led alternative. The Congressional Budget Office
(CBO), a politically independent agency, estimated that if the American
Health Care Act had past would eventually lead to 24 million people loosing
their health care insurance by 2026.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Rethinking The Obligation To Provide Universal Healthcare Coverage: The need for moral imagination

Healthcare is indeed complicated, in case anyone with a
speck of knowledge about it ever thought otherwise. There are many ways to
organize a healthcare system, as is evident from all the various ways advanced
industrial societies around the globe provide healthcare to their citizens.
Questions about the extent to which the private insurance system versus the
government is involved brings us back to protracted debates about the legitimate
role of government and whether or not citizens have a basic right to healthcare,
or should healthcare be assumed to be one more market service which individuals
may elect to use or not? Sadly, in the United States these questions often are
framed in abstract terms appealing to general ideological values and goals that
shape and limit the range of viable policy options. What I want to emphasize in
my blog today is the need for moral imagination—what’s it like to be in the
shoes of those who are suffering, and often without health insurance, and
without a job?  This is a first step we
all must take before we can weigh our moral obligations to provide healthcare
to everyone.

Before the passage of the Affordable Care Act (ACA) there
were over 45 million uninsured Americans who did not have access to a primary
care physician. That number has been reduced by about 18 million, but now we at
risk of seeing this number rise again with the possibility of a repeal of the
ACA and passage of a GOP led alternative. The Congressional Budget Office
(CBO), a politically independent agency, estimated that if the American
Health Care Act had past would eventually lead to 24 million people loosing
their health care insurance by 2026.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals: February 2017 by Christine Sargent

American Ethnologist

Good ramps, bad ramps: Centralized design standards and disability access in urban Russian infrastructure

Cassandra Hartblay

Accessible design seeks to reconfigure the social by restructuring the material. As the idea moves globally, it becomes entwined in local logics of moral obligations between citizens and the state. Wheelchair users in the city of Petrozavodsk, in northwestern Russia, talk about inaccessible infrastructure as being embedded in moral relationships. In their stories, hierarchies of expertise diffuse responsibility for outcomes and devalue user knowledge. When accessible design elements are installed to meet minimum standards, they are “just for the check mark” and often do not “work.” Wheelchair ramps produce value for businesses or governments by representing an idea of access that circulates as a commodity. Failed accessible design draws attention to a moral field governing the responsibilities of actors to produce a “good” built environment, imbricated in teleologies of progress. [disability, design, infrastructure, access, ramps, postsocialism, Russia]

Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center

Rebecca J. Lester

“The self” has seen a surprising resurgence in recent anthropological theorizing, revitalizing interest in whether and how it can be studied ethnographically. These issues are brought to the fore by a newly popular psychotherapy technique, Internal Family Systems therapy (IFS), as practiced in a US eating-disorders clinic. There, clinicians and clients negotiate tensions between this model’s understanding of a multiple, refracted self and managed-care companies’ insistence on personal responsibility. In considering the moral and pragmatic work of IFS in the clinic, a new critical anthropology of selfhood illuminates the vectors through which economic and political commitments become imbricated in the self.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Part I: LOVING and Bioethics The Right to Marry

[embedded content]LOVING – Official Trailer from Mill Valley Film Festival on Vimeo.

Courtesy Focus Films
LOVING was the closing night film of the 39th Mill Valley Film Festival. Jeff Nichols is its writer/director. At 38 years old, born in Little Rock, Arkansas, Nichols is a master at breaking stereotypes about cultures, especially those below the Mason Dixon Line.  

LOVING is based on the lives of Mildred  and Richard Loving. The portrayals by Ruth Negga and Joel Edgerton in the title roles is an exquisitely intimate, internal portrait. The main characters met young, fell in love in a poor rural neighbor of Virginia where races interacted socially. The love aspect of the story is prominent but the underclass nature of interracial life in the region is equally as strong. In 1958, the couple were forbidden to marry because their state was among many with anti-miscegenation laws.  

Nichols’ LOVING is as much about class— working poor—as it is about race. As long as Mildred and Richard kept within the constraints of the geo-social ‘Bottoms’ the state powers would not care. They weren’t so much jailed because Mildred was Black while Richard White but because they dared want their love and children legitimated. Anti-miscegenation laws stemmed, above all else not from morality but economics—controlling who could own property, historically determined by parentage. The law they violated was a vestige of slavery in their state.

LOVING, the feature length fictional film, evolved from director Nichols’ admiration for a documentary made years before. Nichols LOVING defies the Hollywood Film industries tendency to make heroism only a characteristic of overtly  “charismatic people.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Justice Cryogenically Delayed is Justice Denied?

Guest Post by Nils Hoppe

Re JS (Disposal of Body) [2016] EWHC 2859 (Fam)

This unusual and sad case concerns a court application by a 14 year old girl, JS.  In 2015 she was diagnosed with a rare form of cancer which proved terminal and, at the time of her application, she was receiving palliative care as an in-patient at a hospital.  The other parties involved in the application were JS’s parents, who were acrimoniously divorced.  JS had no direct contact with her father after 2008.

Knowing that she would soon die, JS carried out online research into commercial cryogenic preservation techniques, defined in the judgment as “the freezing of a dead body in the hope that resuscitation and cure may be possible in the distant future”.  Such techniques are not uncontroversial, being regarded with scepticism by the majority of the medical and scientific community.  They are also not cheap: the judgment describes the costs associated with the basic cryopreservation package as being in the region of £37,000, or, as Mr Justice Peter Jackson put it, “about ten times as much as an average funeral”.

Of most significance to the court application was the fact that the proposed procedure required the cooperation of the hospital in which JS was a patient.  This concern was described in the following terms by the judge:

The body must be prepared within a very short time of death, ideally within minutes and at most within a few hours.  Arrangements then have to be made for it to be transported by a registered funeral director to the premises in the United States where it is to be stored. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

What is a moral epigenetic responsibility?

Guest Post: Charles Dupras & Vardit Ravitsky

The ambiguous nature of epigenetic responsibility

Epigenetics is a recent yet promising field of scientific research. It explores the influence of the biochemical environment (food, toxic pollutants) and the social environment (stress, child abuse, socio-economic status) on the expression of genes, i.e. on whether and how they will switch ‘on’ or ‘off’. Epigenetic modifications can have a significant impact on health and disease later in life. Most surprisingly, it was suggested that some epigenetic variants (or ‘epi-mutations’) acquired during one’s life could be transmitted to offspring, thus having long-term effects on the health of future generations.

Epigenetics is increasingly capturing the attention of social scientists and ethicists, because it brings attention to the importance of environmental exposure for the developing foetus and child as a risk factor for common diseases such as cardiovascular, diabetes, obesity, allergies and cancers. Scholars such as Hannah Landecker, Mark Rothstein and Maurizio Meloni have argued that epigenetics may be used to promote various arguments in ongoing debates on environmental and social justice, as well as intergenerational equity. Some even suggested that epigenetics could lead to novel ways of thinking about moral responsibilities for health.

Is it fair that disadvantaged populations are exposed to an inequitable share of harmful environments – such as polluted areas – that are epigenetically-detrimental to their health? Who should be held responsible for protecting children and future generations from epigenetic harm induced by their environments? Should we hold the parents accountable for detrimental epigenetic impact of their behavior on their children?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Cross Post: Next time you ask the doctor for some antibiotics – consider whether you’re being immoral

Written by Alberto Giubilini, Postdoctoral Research Fellow, Oxford Uehiro Centre for Practical Ethics

This article was originally published in The Conversation

Antimicrobial resistance is the ability of microorganisms causing infections to survive exposure to antimicrobial drugs such as antibiotics. This is considered by some to be a slowly emerging disaster. According to the recently released Review on Antimicrobial Resistance commissioned by the UK government, by 2050 some 10m lives a year will be at risk because of drug resistant infections.

Examples of resistant “superbugs” include methicillin-resistant staphylococcus aureus (MRSA), extremely drug resistant tuberculosis, gonorrhoea, typohoid fever, and group A streptococcus.

Although the evolution of resistant strains is a naturally occurring phenomenon, antimicrobial resistance (AMR) is accelerated by the misuse and abuse of currently available antimicrobials in healthcare and in agriculture (including animal farming), to which microbes adapt. In fact, a positive correlation has been demonstrated between antibiotics resistance rates and antibiotics consumption.

To put it simply: it is the human factor that drives AMR. The US Centers for Disease Control said that “the single most important action needed to greatly slow down the development and spread of antibiotic resistant infections is to change the way antibiotics are used”.

In order to reduce AMR rates we need to reduce the consumption of antibiotics. According to a recently released UK government’s report, “AMR is not a problem that can be solved by any one country, or even any one region. We live in a connected world where people, animals, and food travel, and microbes travel with them.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Politics of Fetal Pain: Why This Is Not A Legislative Issue


I read with interest the recent
blog
by my colleagues Paul Burcher and Claire Horner entitled “The Politics
of Fetal Pain”. In their blog they discuss the recent
fetal
pain bill
passed in Utah, which “requires the use of general anesthesia on women seeking
abortions at 20 weeks gestation or later.” At stake is the concern that fetuses
may be capable of experiencing pain by 20 weeks, which has prompted 12 states
to restrict or prohibit abortions from that point on, instead of 24 weeks,
which is the current standard.


 


Burcher and Horner remind us that the issue of fetal pain has
been a source of contention for
some
time,
which has led to “several states restricting or
prohibiting abortions
 20 weeks or later on the basis of potential fetal pain.” The
authors are very much aware of the possibility that anti-abortion advocates may
be using this issue as a convenient means by which to place additional limits
on abortion rights of women. Which is to say, anti-abortion advocates
supporting these restrictions on women’s reproductive rights may be using the
fetal pain issue as a means to restrict abortion rights. Even if they do have a
bias in creating this law, Burcher and Horner still believe that the law itself
is justified.


 


Though I would
share a concern about the possibility of fetal pain, if I had reason to believe
there were evidence to support it, I disagree that the appropriate next move
ethically is to join forces with a legislative agenda of politicians whose
interests go far beyond the issue of fetal pain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Organ Mules

Julian Savulescu

While politicians wring their hands about sensible solutions to the organ shortage, scientists are progressing with genetic manipulations that may see human organs grown in pigs.

US scientists are creating novel life forms: “human pig chimeras”. These are a blend of human and pig characteristics. They are like mules who will provide organs to us. A mule is the offspring of a male donkey (jack) and a female horse (mare). Horses and donkeys are different species, with different numbers of chromosomes but they can breed together.

In this case, they take a skin cell from a person and turn it back in time to make stem cells capable of producing any cell or tissue in the body, “induced pluripotent stem cells.” They then inject this into a pig embryo. This makes a pig human chimera.

However they do a modification to the pig embryo first. They use gene editing, or CRISPR, to knock out the pig’s genes which produce an organ, say the pancreas. The human stem cells for the pancreas then make an almost entirely human pancreas in the pig human chimera. It functions like an organ mule. (The blood vessels are still porcine.)

In this way, your skin cell could grow a new liver, heart, pancreas, or lung.

This is a technique with wider possibilities: other US teams are working on a chimera –based treatment, this time for Parkinson’s disease which will use chimeras to create human neurones.

CRISPR is also credited with enhancing the safety of this technique, with the BBC reporting  that a Harvard team were able to use the new and revolutionary technique to remove copies of a pig retrovirus.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.